Cardiac Transplantation for Pediatric and Congenital Cardiac Disease

History of Cardiac Transplantation

The first successful heart transplant was performed by Christian Barnard in South Africa on December 3, 1967.[1] This clinical success was based on experimental work done by Richard Lower and Norman Shumway at Stanford.[2] During the next year, over 100 cardiac transplants were performed around the world.[3] Unfortunately, most of the patients died of either allograft rejection or overwhelming infection. The introduction of percutaneous transvenous right ventricular endomyocardial biopsy (1972) and a standardized grading system for cardiac rejection (1974) were developed by the team at Stanford.[4],[5] These advances, along with the introduction of cyclosporine, led to improved survival and acceptable outcomes.[6]

Incremental improvements in outcomes after cardiac transplantation have resulted from multiple advances:

• the introduction of percutaneous transvenous right ventricular endomyocardial biopsy (1972),
• a standardized grading system for cardiac rejection (1974),
• the introduction of cyclosporine,[6]
• use of the bicaval technique,[7]
• tacrolimus (FK506) immunosuppression,[8]
• steroid free immunosuppression,[9] and
• induction therapy with monoclonal antibodies.[10]

Infant cardiac transplantation was first successfully performed by Dr. Leonard Bailey at Loma Linda University on November 20, 1985.[11] This followed attempts at clinical Xenotransplantation by the Loma Linda group.[12] A major advance occurred with the introduction of ABO incompatible cardiac transplantation for infants in 2001, allowing expansion of the donor pool.[13] Currently, infant and pediatric cardiac transplantation accounts for 10% of all cardiac transplants.